| HEALTH CARE, MEDICARE, MEDICAID
This plan puts a lot of faith in the ability of individuals to make decisions about buying health insurance. How does the plan assure people won’t get hoodwinked by insurance companies in making these complex choices?
For a free society to function, citizens must be free to choose. The Roadmap health care reforms allow the American people to reclaim their decision-making power from faceless bureaucrats – whether at an insurance company or the federal government.
Americans are already making decisions about where to buy the health insurance and what types of benefits they want to pay for. The problem for many Americans is that they are being forced to choose from a shrinking number of options with little information about what it is they are actually purchasing. Health care in America should be easier to navigate, more affordable, and more portable. Without transparent rules and competition for patients’ business, the opaque and distorted health care market will continue to fail the American public. Patients should have convenient and affordable options, and they should have control of those options.
What we need—and what this Roadmap promotes —is a consistent and fair market, so that every citizen has access to affordable coverage. Patients could choose which health care provider they trust. The freedom to choose creates better competition, fosters higher quality care, and lowers costs to levels that are fair for every American in every state.
States should provide direct oversight of health insurers to make sure they are playing by fair rules. Encouraging the creation of State-run heath exchanges will give patients and doctors the assurance of a transparent and efficiently regulated insurance market. And by promoting risk adjustment models, there will no longer be an incentive for insurers to game the system by trying to deny coverage to the sick while only covering the healthy.
At the same time, health care organizations have begun publishing prices for various services to give patients a better understanding of what their costs will be. Other services are also available for patients to use online tools that allow them to search for health care providers based on quality surveys and other ratings based information. Members of Congress and federal employees are using these tools today to choose the health care plan that fits their needs. I believe it is essential that all Americans are able to make these same choices.
What does this plan do to ensure coverage for the chronically ill, such as those with HIV or cancer? How will they get coverage in the private market?
My Roadmap takes on many of the insurance industry practices that have left millions without access to critical health care services. It ends companies’ ability to deny coverage based on pre-existing conditions, requires all insurers offer coverage to people looking for a plan in a State exchange, and encourages opportunities for automatic enrollment through places of employment, emergency rooms, the DMV, and job centers among others.
Also, these State exchanges will be required to offer high risk pools or reinsurance mechanisms to ensure that everyone, regardless of their health condition, will have access to affordable coverage. High risk pools offer a safety net for those with serious medical issues that are costly to treat.
Doesn’t your plan simply dismantle Medicare and Medicaid as entitlements and put health care at risk for millions of poor people and the elderly who depend on it?
The Roadmap saves Medicare and Medicaid. It secures these programs for current beneficiaries and senior nearing retirement, while making the critical changes to secure the program for future beneficiaries. The greatest threat to these programs comes from those who propose to do nothing – and sit idly by while our social safety net implodes. The innovative Roadmap reforms strengthen the safety net that many people enrolled in these programs rely on.
This plan ensures Medicare beneficiaries who are counting on receiving a benefit actually have one – by making all future beneficiaries eligible for an income-related, risk-adjusted Medicare payment to obtain coverage that best Low-income beneficiaries get higher payments and fully funded medical savings accounts to cover out-of-pocket medical costs. In addition, the payment is risk-adjusted, so those with greater health needs receive additional assistance.
The bill also modernizes Medicaid by giving states maximum flexibility to tailor their Medicaid programs to the specific needs of their populations. It also allows Medicaid recipients to avail themselves of the health coverage choices open to everyone else through the universal, refundable tax credit option. For States that want to continue their Medicaid programs as currently structured, they may do so under my plan. The only change would be that federal matching funds would distributed in the form of a block grant and increased every year in a way that would help restrain overall health care spending.
Response to New York Times’ factually inaccurate claim that Roadmap “ends Medicare”
More choices in Medicare will cause more headaches and confusion for seniors. Why not simply shore up the existing program, and assure beneficiaries they will get the coverage they have planned for?
This plan actually simplifies the Medicare system. Currently, beneficiaries are forced to navigate a system the government has prescribed for them – not one they’ve picked to best suit their health care needs. Medicare poorly targets its benefits, as it overpays in many areas and significantly underpays in other areas. By targeting Medicare resources specifically to the needs of seniors, Medicare can be much more effective and responsive in ensuring health security for America’s seniors. Instead of the government deciding what type of care each beneficiary should receive, beneficiaries will be able to decide for themselves — similar to the way Members of Congress and Federal employees choose their health care coverage.
CBO says that the average Medicare payment beneficiaries see when your program goes into effect is $6,500. How do you expect seniors to find a credible insurance plan for such a small amount?
The $6,500 figure cited by CBO represents the average amount the first group of beneficiaries who are eligible to participate in this new Medicare program could receive. A crucial element of my reform plan is the risk adjustment that is introduced into the Medicare program. Under this system, beneficiaries receive payments adjusted to reflect their health status and age, ensuring older and sicker seniors receive larger payments to accommodate their higher out of pocket costs. Since the first group receiving the Medicare payment will all be the same age when the new program begins, the average payment amount in the first year is lower than the fully phased in average of $11,000, as noted by CBO.
Is a $5,700 tax credit really enough for a family of four to buy insurance?
As a result of biases in the current tax code, Americans who receive their health benefits from their employer pay roughly 1/3 of the total health coverage costs, while their employer pays roughly 2/3. So if the total cost of an employee’s health plan is $15,000, the employer covers $10,000, while the employee pays $5,000 in annual premiums. Under the Roadmap, employees would be provided an advanceable, refundable tax credit - $5,700 for families – that will more than pay for an employee’s part of their health care premiums. Furthermore, employers will still be able to offer health coverage to their employees, untaxed. This means there is no incentive from a tax perspective for employers to change the way they offer health insurance. Employees will be able to use the overages to pay for preventative care, and can be rolled over annually.
Furthermore, redirecting the tax benefit from corporations to individuals and families will increase wages for hardworking Americans. By allowing for higher take-home pay combined with the new tax credit, the Roadmap would effectively increase workers’ wages.